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How do microorganisms grow?Most microorganisms “grow” by multiplication. Tomultiply, microorganisms need: Food; Water; Time; and Warmth.Meat, seafood, cooked rice, cooked pasta, milk,cheese and eggs are foods that provide idealconditions for microorganisms to grow.Additional informationOne bacterium can become 2 in just 15 minutes.This means that within 6 hours, 1 bacterium canmultiply to over 16 million.To be harmful, some bacteria need to grow to highlevels. Other bacteria can cause illness when theyare present in very low numbers.Viruses are many times smaller than bacteria. Theydo not grow in food or water, but these are vehiclesfor transmission.Considerations and suggestions for the trainer Discuss local foods that do and do not provide the ideal conditions for growth of microorganisms. Dried beans, pebbles or other objects can be used to demonstrate bacterial growth. As an example of quickgrowth start with one object, in 15 seconds make it two objects, in another 15 seconds make it 4 objects andin another 15 seconds make it 8 objects, etc. (double the number of objects you have every 15 seconds). Pleasenote that 15 seconds is used instead of 15 minutes so that it is possible to show how bacteria grow during atraining session.What are the symptoms of foodborne disease?Additional informationEvery year, billions of people experience one or moreepisodes of foodborne disease, without ever knowingthat their illness was caused by food.For infants, the sick, pregnant women and theelderly, the consequences of foodborne disease areusually more severe and more often fatal.The most common symptoms of foodborne diseaseare:Drinking plenty of fluids will maintain hydrationduring diarrhoea. Stomach pains; Vomiting; andIt is estimated that 3% of cases of foodbornedisease can lead to long-term health problems. Diarrhoea.The symptoms depend on the cause of the disease.Symptoms may occur very quickly after eating thefood, or may take days or even weeks to appear. Formost foodborne diseases, symptoms occur 24 -72hours after the food has been eaten.Foodborne disease can lead to long-term healthproblems. Very severe diseases, including cancer,arthritis and neurological disorders can be caused bycontaminated food.Mouth masks are recommended for people who maycough or sneeze while handling food. Gloves canbe used to cover any cuts or lesions and should bechanged frequently.Advice on treatment of foodborne illness differsbetween countries and should be adapted to thelocal region. However, one should seek medicaladvice when bowel movements are very frequent,very watery or contain blood, or last beyond 3 days.FIVE KEYS TO SAFER FOOD MANUAL9

What to do if you get sickTry not to handle or prepare food while you are sickand for 48 hours after your symptoms stop. However,if this cannot be avoided, wash your hands withsoap and water first and frequently during foodpreparation.Some foodborne diseases can be transferred fromperson to person. Caregivers can become sick frompatients with a foodborne illness.When symptoms are severe seek medicaladvice immediately.Considerations and suggestions for the trainer Food industry workers need to notify their employers of the following: Hepatitis A, diarrhoea, vomiting, fever,sore throat, skin rash, other skin lesions (e.g. boils, cuts, etc.) or discharge from ears, eyes or nose. High risk activities such as slaughtering and preparing ready to eat foods may require special personalprotective equipment. Contact the local government authority for more information.Chemicals should not be forgottenMicroorganisms are not the only cause of foodborneillness. People also get sick from poisonous chemicals,which include: Natural toxins; Metals and environmental pollutants; Chemicals used for treating animals; Improperly used pesticides; Chemicals used for cleaning; and Improperly used food additives.Additional information“Poisoning” is a term used to describe sicknessresulting from chemical contamination.Some “natural” toxins (e.g. aflatoxin) are caused bymoulds growing on the food.Ingesting aflatoxins may have harmful effects on theliver that can lead to cancer.Simple measures such as washing and peeling mayreduce the risk from chemicals that are found on thesurface of foods.Appropriate storage can avoid or reduce theformation of some natural toxins.Considerations and suggestions for the trainer10 It may be useful to elaborate on some of the chemicals that are a threat to specific populations (e.g.methylmercury, arsenic). Discuss the importance of reading and understanding instructions on the labels of chemicals used for cleaning. Using cookware and utensils glazed with materials containing heavy metals (e.g. lead, cadmium) can result inchemical poisoning. Discuss appropriate cookware.S E C T I O N O N E : B A C K G R O U N D M AT E R I A L

S e c t i o n Tw o : F i v e K e y s t o S a f e r F o o dKEEP CLEANCore information Wash your hands before handling food and oftenduring food preparation Wash your hands after going to the toilet Wash and sanitize all surfaces and equipmentused for food preparation Protect kitchen areas and food from insects,pests and other animalsWhy?While most microorganisms do not cause disease,dangerous microorganisms are widely found in soil,water, animals and people. These microorganismsare carried on hands, wiping cloths and utensils,especially cutting boards, and the slightest contactcan transfer them to food and cause foodbornediseases.Considerations and suggestions for the trainerJust because something looks clean does not mean that it is. It takes over 2.5 billion bacteria to make 250 ml ofwater look cloudy, but in some cases it takes only 15-20 pathogenic bacteria to make one sick.If slaughtering of animals at home is practised in your region, the following information is very important.12 Keep the area clean and separate from food preparation areas. Change clothes and wash hands and equipment after slaughtering. Do not slaughter sick animals. Be aware of on-going diseases in your area such as Avian influenza. Human health risks from these diseasesmay require additional controls such as using personal protective gear. Contact the local government authorityfor further information. Remove faeces from the home and keep it separate from food growing, preparation and storage areas. Wash hands to prevent contamination with faecal material. Keep domestic and other live animals away from the food growing, preparation and storage areas (e.g. pets,poultry, animals raised in the home).KEEP CLEAN

E VA L UAT I O N F O R M SI: For the organizer and/or trainerThis form evaluates the demographics of the audience, the suitability of the adaptation process and whetheror not the training session achieved its goal.Demographics of the Audience1. Who was the audience?2.What was the age range of the audience?3.What was the general educational level of the audience? 4. No education Low education High educationWhat was the average literacy level of the audience? Cannot read Can read a little Can read5. What was the living environment of the audience? Rural Urban6. Were there any cultural practices that compromised food safety? Yes NoIf yes, please describe these practices7. What resources are available to the participants? (tick all appropriate boxes and add any sources that arenot listed) 22 Safe water Thermometer Running water Oven Refrigerator Human waste disposal Electricity OtherE VA L U AT I O N F O R M S

Adaptation of the Five Keys to Safer Food Manual8. Do you think the level of language in the Five Keys to Safer Food poster was appropriate? 9. Yes No Do you think the manual presents the Five Keys to Safer Food information clearly? Yes NoIf no, please explain10. How did you adapt Key 1 (Keep clean)?11. How did you adapt Key 2 (Separate raw and cooked)?12.How did you adapt Key 3 (Cook thoroughly)?13.How did you adapt Key 4 (Keep food at safe temperatures)?14.How did you adapt Key 5 (Safe water and raw materials)?15.Was there a general adaptation made for the audience?16.Please provide feedback on audience participation, concerns and accomplishments.17. Please provide recommendations for changes to the manual (e.g., inclusions, deletions, edits).FIVE KEYS TO SAFER FOOD MANUAL23

II: For the participantsThis form evaluates the food safety knowledge, attitude and behaviour of theparticipants. Participants should complete the form before and after training.KnowledgeKey 1 – Keep clean1a. It is important to wash hands before handling food. True False1b. Wiping cloths can spread microorganisms. True False2a. The same cutting board can be used for raw and cooked foodsprovided it looks clean. True False2b. Raw food needs to be stored separately from cooked food. True False3a. Cooked foods do not need to be thoroughly reheated. True False3b. Proper cooking includes meat cooked to 40 C. True False4a. Cooked meat can be left at room temperature overnight to coolbefore refrigerating. True False4b. Cooked food should be kept very hot before serving. True False4c. Refrigerating food only slows bacterial growth. True False5a. Safe water can be identified by the way it looks. True False5b. Wash fruit and vegetables. True FalseKey 2 – Separate raw and cookedKey 3 – Cook thoroughlyKey 4 – Keep food at safe temperaturesKey 5 – Use safe water and raw materialsAnswers: p. 2624E VA L U AT I O N F O R M S

AttitudeKey 1 – Keep clean1a. Frequent hand-washing during food preparation is worth the extra time. Agree Not sure Disagree1b. Keeping kitchen surfaces clean reduces the risk of illness. Agree Not sure DisagreeKey 2 – Separate raw and cooked2a. Keeping raw and cooked food separate helps to prevent illness. Agree Not sure Disagree2b. Using different knives and cutting boards for raw and cooked foods is worth the extra effort. Agree Not sure DisagreeKey 3 – Cook thoroughly3a. Meat thermometers are useful for ensuring food is cooked thoroughly. Agree Not sure Disagree3b. Soups and stews should always be boiled to ensure safety. Agree Not sure DisagreeKey 4 – Keep food at safe temperatures4a. Thawing food in a cool place is safer. Agree Not sure Disagree4b. I think it is unsafe to leave cooked food out of the refrigerator for more than two hours. Agree Not sure DisagreeKey 5 – Use safe water and raw materials5a. Inspecting food for freshness and wholesomeness is valuable. Agree Not sure Disagree5b. I think it is important to throw away foods that have reached their expiry date. Agree Not sure DisagreeAnswers: p. 26FIVE KEYS TO SAFER FOOD MANUAL25

Self-reported behaviourKey 1 – Keep clean1a. I wash my hands before and during food preparation. Always Most times Sometimes Not often Never1b. I clean surfaces and equipment used for food preparation before re-using on other food. Always Most times Sometimes Not often NeverKey 2 – Separate raw and cooked2a. I use separate utensils and cutting-boards when preparing raw and cooked food. Always Most times Sometimes Not often Never Sometimes Not often Never2b. I separate raw and cooked food during storage. Always Most timesKey 3 – Cook thoroughly3a. I check that meats are cooked thoroughly by ensuring that the juices are clear or by using athermometer. Always Most times Sometimes Not often Never Not often Never Not often Never3b. I reheat cooked food until it is piping hot throughout. Always Most times SometimesKey 4 – Keep food at safe temperatures4a. I thaw frozen food in the refrigerator or other cool place. Always Most times Sometimes4b. After I have cooked a meal I store any left-overs in a cool place within two hours. Always Most times Sometimes Not often Never Not often Never Not often NeverKey 5 – Use safe water and raw materials5a. I check and throw away food beyond its expiry date. Always Most times Sometimes5b. I wash fruit and vegetables with safe water before eating them. Always Most times SometimesANSWERS1a)2a)3a)4a)5a)AttitudeAgree, 1b) AgreeAgree, 2b) AgreeAgree, 3b) AgreeAgree, 4b) AgreeAgree, 5b) AgreeSelf-reported1a) Always, 1b)2a) Always, 2b)3a) Always, 3b)4a) Always, 4b)5a) Always, 5b)behaviourAlwaysAlwaysAlways,AlwaysAlwaysE VA L U AT I O N F O R M SKnowledge1a) True, 1b) True2a) False, 2b) True3a) False, 3b) False4a) False, 4b) True, 4c) True5a) False, 5b) True26

GLOSSARYBacteriaA microscopic organism which may be found in the environment, in foods and on animals.Bleach (chlorine)A strong smelling liquid containing chlorine that is used for disinfecting food contact surfaces andsanitizing plates and utensils.ContaminantAny biological or chemical agent, foreign matter or other substances not intentionally added tofood that may compromise food safety or suitability.Cross-contaminationThe introduction of microorganisms or disease agents from raw food into ready-to-eat foodmaking it unsafe.Danger zoneThe temperature range 5 C to 60 C, in which microorganisms grow and multiply very fast.DiarrhoeaA disorder of the intestine marked by abnormally frequent and fluid evacuation of the bowels.DisinfectionThe reduction by means of chemical agents and/or physical methods, of the number of microorganisms in the environment, to a level that does not compromise food safety or suitability.EquipmentAll stoves, hot-plates, cutting boards, tables and kitchen surfaces/counters, refrigerators andfreezers, sinks, dishwashers and similar items (other than utensils) used in food processing andfood service establishments.FaecesWaste matter or excrement eliminated from humans and animals.FoodAny plant or animal product prepared or sold for human consumption. Includes drink andchewing substances and any ingredient, food additive or other substance that enters into or isused in the preparation of food. Does not include substances used as a drug or medicine.Foodborne diseaseA general term used to describe any disease or illness caused by eating contaminated food ordrink. Traditionally referred to as “food poisoning”.Food contact surfacesSurfaces of equipment and utensils normally in contact with food.Food handlerAny person who directly handles packaged or unpacked food, food equipment and utensils or foodcontact surfaces, and is therefore expected to comply with food hygiene requirements.Food hygieneAll conditions and measures necessary to ensure the safety and suitability of food at all stages ofthe food-chain.Food preparationThe manipulation of food intended for human consumption by processes such as washing, slicing,peeling, shelling, mixing, cooking and portioning.Food safetyAll measures to ensure that food will not cause harm to the consumer when it is prepared and/oreaten according to its intended use.MicroorganismsMicroscopic organisms such as bacteria, moulds, viruses and parasites, which may be found in theenvironment, in foods and on animals.PathogenAny disease-causing microorganism such as a bacterium, virus or parasite. Often referred to as a“germ” or “bug”.Perishable foodFood that spoils within a short amount of time.Pest controlThe reduction or elimination of pests such as flies, cockroaches, mice and rats and other animalsthat can infest food products.RiskIs the severity and likelihood of harm resulting from exposure to a hazard.Ready to eatFood that is consumed without any further preparation, such as cooking, from the consumer.ToxicHarmful or poisonousUtensilsObjects such as pots, pans, ladles, scoops, plates, bowls, forks, spoons, knives, cutting boards orfood containers used in the preparation, storage, transport or serving of food.VirusA non-cellular, microscopic infectious agent that relies upon a host cell to reproduce.FIVE KEYS TO SAFER FOOD MANUAL27

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not usually make people sick, but they cause our food to smell bad, taste horrible and look disgusting. Dangerous microorganisms make people sick and can even kill. These are called “pathogens”. Most of these microorganisms do not change the appearance of the food. Microorganisms are so